The study was performed to investigate a new bone-ligament-bone autograft from the plantar plate of the toes. The anatomic properties of the plantar ligaments and the technical feasibility to harvest a bone-ligament-bone graft were examined to evaluate the potential use of this graft for a suitable reconstruction of the scapholunate (SL) interosseous ligament. The plantar plate of the metatarsophalangeal joints of the second to fifth toe and the proximal interphalangeal joints of the second to fourth toe were examined in 20 cadaver feet (15 fresh and 5 embalmed cadavers) and measurements such as length, thickness, and width were taken. The average length of the plantar ligaments of the proximal interphalangeal joint was 0.63 cm (D3) and 0.62 cm (D4). The length of the plantar plates of the proximal interphalangeal joint of the third and fourth toe was found to be similar to that of the SL ligament. In addition to the measurements, a bone-ligament-bone autograft of the plantar plates of the metatarsophalangeal joint was designed as an SL-ligament substitute and successfully transplanted into cadaveric wrists. This new autograft is intercalated between the scaphoid and lunate and, contrary to all previous methods, not simply superimposed upon them. Length of the plantar plates was considered by the authors as the main criteria for selection of the new bone-ligament-bone graft. The plantar plate of the proximal interphalangeal joint of the third and fourth toe showed a similar length compared with the SL ligament. Therefore, it can be concluded from the data that this bone-ligament-bone graft can be a suitable replacement for the SL ligament.
InstituteDie Methods and Patients:Retrospectively the results of 100 trapezium resections in 72 patients with subsequent joint replacement by a Swanson silicone prosthesis have been followed up over 8.6 years on average. Besides the range of motion, the strengh in grip, tip pinch and key pinch were measured. The quality of pain was determined using a visual analogus pain scale from 1-10. The postoperative subjective satisfaction of patients was recorded as well as the DASH, Mayo, modified Wrist and Krimmer scores. In follow-up X-ray controls, subluxations of the silicone implants as well as bony abnormalities were evaluated. Results:The postoperative range of motion of the trapeziometacarpal joint in radial abduction was measured with 52 ° and at palmar abduction with 39 °. The average grip strength amounted to 16.5 kg. This represented 80 % of the value of the contralateral side. In tip pinch the force value was 3.3 kg, corresponding to 70 % of that of the opposite side and in key pinch, it was 3.5 kg, corresponding to 71 % of the healthy contralateral side. The DASH score was recorded with 22.5 points. Postoperative pain symptoms on the visual analogue pain scale were recorded at 2.4 points. The majority of the patients were satisfied or very satisfied after the surgical treatment. In X-ray controls, subluxations of the silicone implants could be detected in 54 cases (61.4 %) as well as bony abnormalities in 41 cases (46.6 %). However, there was no correlation between the radiological findings and patient satisfaction. Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
that lateral trauma can give dislocation because fracture of the metacarpal bone is impossible and the axial trauma of the thumb could destroy the osteointegration of the cup. This prosthesis seems a good possibility for treating the painful osteoarthritis of CMC joint of the thumb.Ligamentous capsulodesis or bone-ligament-bone grafts are established methods to reconstruct the scapholunate interosseous ligament in chronic scapholunate dissociation. The purpose of our anatomical study was to create a new bone-ligament-bone-graft, which can be used as an anatomical replacement for the scapholunate interosseous ligament.The plantar aponeurosis of the metatarso-phalangealjoint of the second to fifth toe as well as of the proximalinterphalangeal joint of the second to fourth toe were examined. The length as well as the thickness of the ligamentous structures of the joints of 20 human cadaveric specimens (40 feet) were measured. The length -the most important category -of the metatarsophalangeal-joints proved to be significantly larger than the original SL-ligament in all cases. In contrast, the SLligament showed a similar length compared to the plantar aponeurosis of the proximal-interphalangealjoint of the forth and third toe. The average length of the plantar aponeurosis (D4) was 0.62 cm (range 0.4-0.8 cm), the average length of D3 0.63 cm (range 0.4-0.8 cm). The average thickness of the plantar aponeurosis of the proximal-interphalangeal-joint D3 and D4 was 0.7 mm (range 0.3-1.4 mm). The width of the plantar aponeurosis of the PIP-joint was 0.82 cm (range 0.70-0.93 cm) on average at D3 and 0.78 cm (range 0.60-1.00 cm) at D4. A small wedge-shaped piece of bone attaching the ligament proximal and distal could be separated using a bone saw. Finally, a boneligament-bone-graft of the aponeurosis of the metatarso-phalangeal-joint as a SL-ligament substitute was designed and could be transplanted in cadaveric hands. The new bone-ligament-bone graft is located between the scaphoid and lunate like the original SL-ligament. Additional biomechanical studies investigating the strength of the newly designed graft have to be done in the near future.
It can be concluded from the data that this new graft of the proximal interphalangeal joint of the 3rd and 4th toes can be a suitable replacement for the scapholunate ligament.
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